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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 3  |  Page : 317-318

Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation


1 Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Submission07-May-2013
Date of Decision09-May-2013
Date of Acceptance30-May-2013
Date of Web Publication16-Jul-2013

Correspondence Address:
Rajesh Verma
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.115083

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How to cite this article:
Verma R, Sahu R, Singh AS, Atam V. Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation. Neurol India 2013;61:317-8

How to cite this URL:
Verma R, Sahu R, Singh AS, Atam V. Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation. Neurol India [serial online] 2013 [cited 2019 Dec 8];61:317-8. Available from: http://www.neurologyindia.com/text.asp?2013/61/3/317/115083


Sir,

A 68-year-old man presented with moderate grade, continuous fever of 15 days duration and sudden onset weakness of left half of body with facial asymmetry, 10 days prior to admission. He had no skin rash or any other bleeding manifestation. He had no history of hypertension, diabetes mellitus or ischemic/valvular heart disease. On clinical examination, he was conscious and oriented, febrile with stable vitals and all peripheral pulses were well felt. Neurological examination revealed left upper motor neuron facial paresis, left motor hemiparesis (grade 1/5) with brisk deep tendon reflexes and an extensor left plantar response. Hemogram revealed leukocytosis with thrombocytopenia. Non-structural protein 1 antigen for dengue was positive in blood. Cerebrospinal fluid (CSF) study showed 15 cells (all lymphocytes) with normal protein and sugar level. ELISA test was positive for dengue specific immunoglobulin M antibody and non-reactive for varicella zoster, herpes simplex and Japanese encephalitis in serum and CSF. Magnetic resonance imaging of brain showed acute infarct in right parietal region [Figure 1]. 2D echocardiography and carotid doppler study were normal. He was treated conservatively and discharged on low dose aspirin 75 mg once a day and advised limb physiotherapy. Follow-up after 2 months showed partial improvement in limb weakness.
Figure 1: Magnetic resonance imaging brain axial T2‑flair (a) and diffusion weighted image (b) showing acute infarct in right fronto parietal region

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Dengue is the most common mosquito-borne viral disease worldwide. [1] In India, dengue has been endemic and in the recent years the reported frequency of outbreaks is high. Milder forms of dengue infection are asymptomatic, whereas the most severe forms manifesting as dengue shock syndrome with multi-organ failure. [2] Neurological complications of dengue infection include encephalitis, myelitis, Guillain-Barré syndrome and myositis. [3] Stroke in a patient with dengue is more often thrombocytopenia-related intracerebral hemorrhage. However, ischemic stroke as a complication of dengue infection has rarely been reported. [4],[5],[6] Seet and Lim reported a case of dysarthria clumsy hand syndrome in a patient with dengue infection. [6] One of the postulated pathogentic mechanism for ischemic stroke in dengue fever was meningovasculitis. [4] Another possible explanation may be a transient hypercoagulable state during dengue infection. Our patient did not have any other predisposing vascular risk factors for ischemic stroke except for the age. We presume that in this patient dengue infection is probably the cause for the ischemic stroke. Early supportive therapy in presence of dengue fever will help to improve the clinical outcome.

 
  References Top

1.WHO. Dengue and dengue haemorrhagic fever. Factsheet N°117, revised March 2009. Geneva, World Health Organization, 2008.  Back to cited text no. 1
    
2.Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai: A study of clinical profile and outcome. Indian Pediatr 2002;39:1027-33.  Back to cited text no. 2
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3.Verma R, Sharma P, Garg RK, Atam V, Singh MK, Mehrotra HS. Neurological complications of dengue fever: Experience from a tertiary center of north India. Ann Indian Acad Neurol 2011;14:272-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Liou LM, Lan SH, Lai CL. Dengue fever with ischemic stroke: A case report. Neurologist 2008;14:40-2.  Back to cited text no. 4
[PUBMED]    
5.Mathew S, Pandian JD. Stroke in patients with dengue. J Stroke Cerebrovasc Dis 2010;19:253-6.  Back to cited text no. 5
[PUBMED]    
6.Seet RC, Lim EC. Dysarthria-clumsy hand syndrome associated with dengue type-2 infection. J Neurol 2007;254:1129-30.  Back to cited text no. 6
[PUBMED]    


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This article has been cited by
1 Neurological Manifestations of Dengue Infection
Guo-Hong Li,Zhi-Jie Ning,Yi-Ming Liu,Xiao-Hong Li
Frontiers in Cellular and Infection Microbiology. 2017; 7
[Pubmed] | [DOI]
2 Pediatric Ischemic Stroke due to Dengue Vasculitis
Subrat Kumar Nanda,Sita Jayalakshmi,Surath Mohandas
Pediatric Neurology. 2014; 51(4): 570
[Pubmed] | [DOI]



 

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